Recent News
CMS Finalizes 2025 Medicare Physician Fee Schedule
November 7, 2024 On November 1, 2024, the Centers for Medicare & Medicaid Services (CMS) issued the Notice of Final Rulemaking for the 2025 Medicare Physician Fee Schedule (MPFS). Here are the key provisions affecting ABA services: Proposed Carrier Pricing of ABA CPT Codes CMS extended carrier pricing of the CPT codes for adaptive behavior/ABA […]
Aetna Rescinds Policy Ending Telehealth Coverage for ABA Services in December 2023
December 11, 2023 Earlier this year, Aetna issued a statement indicating that they would be ending telehealth coverage of CPT codes 97151, 97153, 97155, 97156, and 97157 as of December 1, 2023. The Coalition wrote to the company in November to ask that they continue telehealth coverage of those services when medically necessary and add telehealth […]
New CPT® Code Available to Report the Use of Virtual Reality Technology with Therapeutic Services
November 16, 2023 New Category III CPT® code 0770T for reporting the use of virtual reality technology during therapies (e.g., psychotherapy, speech therapy, health behavior intervention, occupational therapy, physical therapy, adaptive behavior/ABA services) went into effect on January 1, 2023. Only the practice expense associated with use of the technology is billable. That includes technician time, […]
CMS Finalizes 2024 Medicare Physician Fee Schedule
November 3, 2023 On November 2, 2023, the Centers for Medicare & Medicaid Services (CMS) issued the Notice of Final Rulemaking for the 2024 Medicare Physician Fee Schedule (MPFS). Here are the key provisions affecting ABA services: Proposed Carrier Pricing of ABA CPT Codes CMS extended carrier pricing of the CPT codes for adaptive behavior/ABA […]
CMS Issues 2024 Proposed Medicare Physician Fee Schedule
July 19, 2023 On July 13, 2023 the Centers for Medicare & Medicaid Services (CMS) issued the Notice of Proposed Rulemaking (NPRM) for the 2024 Medicare Physician Fee Schedule (MPFS). Here are the key provisions affecting ABA services: Proposed Carrier Pricing of ABA CPT Codes CMS proposes to extend carrier pricing of the CPT codes […]
CMS Proposes Rules for Calendar Year 2023 Pricing and Telehealth Approval Status of CPT Codes for ABA Services
August 16, 2022 Recently the Centers for Medicare & Medicaid Services (CMS) published the proposed Medicare Physician Fee Schedule (MPFS) and proposed rule changes for 2023. The agency is proposing that the CPT codes for adaptive behavior/ABA services (97151 – 97158, 0362T, 0373T) remain carrier-priced throughout 2023, as they have been since they went into effect […]
Coalition Updates its Model Coverage Policy
January 19, 2022 The ABA Coding Coalition has updated the Model Coverage Policy for Adaptive Behavior Services, which was initially released in September 2020. The updated version includes two additional modifier codes that some payers want providers to use to indicate services that are being provided via telehealth, and some additional ICD-10 and corresponding DSM-V […]
Coalition Advocates for Changes in TRICARE Autism Care Demonstration Billing Code Policies
November 18, 2021 In March the Defense Health Agency (DHA), which manages the TRICARE Autism Care Demonstration (ACD) program, issued revised policies for that program. They included policies on billing with the CPT codes for adaptive behavior/ABA services that are inconsistent with the code descriptors and related documents published by the American Medical Association as […]
CMS Proposes Pricing for CPT Codes, Updates to Telehealth Coverage in 2022 Medicare Physician Fee Schedule
July 29, 2021 The Centers for Medicare & Medicaid Services (CMS) released the proposed 2022 Medicare Physician Fee Schedule (MPFS) and other proposed rule changes on July 13. The document can be found here. Addendum B, which contains all assigned relative value units (RVUs) for services within the MPFS, clearly indicates that the CPT codes for adaptive […]
ABA Coding Coalition Urges CMS to Add ABA CPT Codes to the Approved Telehealth List
June 3, 2021 The Centers for Medicare and Medicaid Services (CMS) publishes a list of services and the corresponding billing codes that are payable under the Medicare Physician Fee Schedule when furnished via telehealth. Many payers use that list to determine whether to authorize telehealth delivery of services. Although CMS approved the 8 Category I CPT codes […]